We’re back once again with our weekend roundup of a few interesting EMR and healthcare IT related tweets. Seems like the #hcsm chat was enjoying tweeting about some of the challenges of EMR and EHR:

@RyanMadanickMD
Ryan Madanick, MD
EMR=elec versn of chart RT @MrPug94: T1 #hcsm There really isn’t a true provider-patient collaboration platform. #EMR is simply a database

I agree with the assertion. Although, the reason an EMR is just a database and not a true provider-patient collaboration platform is because there’s no exchange of data. That’s what’s missing most from today’s EMR software.

Then, I also saw this related tweet about EHR:

@JackWestMD
H. Jack West, MD
Also, w/#EMR, it has never been easier to produce so much boilerplated documentation that says so little. #hcsm

I know where this comment comes from, but as I said in previous posts. I think we’re ready to see a revolution in clinical documentation that kicks against the boiler plate documentation that’s been so dominate in legacy EHR software.

Plus, is anyone else still kind of annoyed that we’re still debating whether to use EMR or EHR?

@EHRgeek
Helen Phung
@ehrwatch @nestorarellano @WittRZ Used interchangeably. #EHR refers more often to a physician/patient facing record while #EMR is for docs.

Personally, I have one thing to say about the EMR or EHR debate: Who cares? Once you can use them interchangeably to communicate the same thing, it really doesn’t matter. I tell you now that it really doesn’t matter.

I recently came across this really interesting Wall Street Journal blog post. In it a recent college graduate gives a nice rendition of the challenge of changing from student to employee. Turns out, this newly minted graduate has found work at the popular healthcare IT software company: Epic.

Of course, the fact that Epic is hiring a recent college graduate should come as no surprise to anyone in the EMR and healthcare IT field. Epic has long been a haven for new graduates since their hiring practices seem to favor training new blood as opposed to hiring experienced EMR practitioners.

However, reading the above post made me think back to when I first got hired for a job working with an electronic medical record. This part of the blog post really hit home (emphasis mine):

Starting Aug 1, I will be calling Madison home. As a project manager for Epic Systems, I will be working with hospitals from start to finish on implementing health care information technology. This position is a wonderful opportunity to work in a young, fast-paced environment with a high level of independence, not to mention a fair amount of travel (which is perfect for an adventurous 21-year-old). Best of all, the ability to help improve patient care, create better processes and in general aid hospital systems is just the kind of feel-good work I was looking for at the beginning of my job search. Preparing to work every day on a beautiful and themed campus that is sure to leave any architecture buff or Indiana Jones fan speechless, I couldn’t be any more excited to begin this next chapter.

While I’m sure we could have a fascinating conversation about some of the points this girl makes about working at Epic, the part in bold took me back to when I had a similar vision.

I remember all too well telling so many people that I was going to have the opportunity working with an EMR to transform the way someone’s healthcare would be provided. I mean, I had the chance to be able to possibly even save people’s lives.

Turns out that I haven’t thought too much about this perspective in the last 5 years. Sure, I guess it’s always in the back of the mind. The focus on patients has always been paramount for me. I believe I truly have made the patient experience and patient care better in the work I’ve done.

Maybe time has just jaded me to too many things and the romance is gone. Certainly I still could be helping to save lives. I guess sometimes the minutiae of what we call work gets in the way of remembering the bigger picture of what’s possible. Maybe that’s why Epic is smart to hire so many recent college grads.

When I learned that HITECH included funds setting up the regional extension center system to support small medical practices in implementing EHRs, I thought, well, that sounds OK.

I wasn’t thrilled, mind you, as I wasn’t optimistic that a government-sponsored organization would produce the quick EHR adoption process HITECH demands, but it wasn’t a bad thing.

Since then, I’ve gone from mildly interested to downright irritated.  While I wasn’t expecting the RECs to blaze a path to glory, I thought it would be nice if they produced great educational materials and sessions, made themselves highly accessible to physicians and offered clear guidance on vendor selection. As far as I can tell, we’re largely zero for three.

Yes, as a recent a recent study notes, the RECs are doing better at some of these things of late. According to a recent study by the eHealth Initiative, they’ve now reached most of the 100,000 PCPs they’d hoped to enroll, and they’ve developed better vendor specifications.

That being said, they really don’t seem to be that focused. Hey, if a privately-funded organization took this long just to begin to get started with their work, they’d already be out of business.

Not only that, when I made one completely unscientific mystery-shopper call to a REC, the staff member I spoke to didn’t seem to have much on the ball. He didn’t have anywhere to direct me for further information, didn’t have any informational meetings pending, couldn’t define clearly what his group could do for me and didn’t even bother to get my contact information.

Of course, that may have been a freak instance, but I’m beginning to doubt it. The buzz I hear is that the RECs have barely a clue as to how to reach their target population, and don’t really speak their language. Some of my EMR-savvy buddies think they’re just about useless.

I do truly hope that the RECs get their act together — maybe all they need is better marketers — but I’m not holding my breath.  My advice to doctors: Keep pushing on your local medical society, your IPA, your hospital partners and your practice management consultants to shed some light on the EMR adoption process. You’ll get further, faster.

Boy, back in the good old days, protecting patient data was comparatively easy. All you had to do was make sure that nobody got their hands on a patient’s paper chart who shouldn’t be looking at it.

After all, simple stuff like locking file rooms and making sure charts never get left in a public place are pretty easy to understand. Sure, paper records get stolen or rifled through now and then — no system is perfect — but putting processes in place to prevent unauthorized chart access isn’t that complicated.

On the other hand, introducing electronic medical records  – plus e-prescribing, digital sharing of lab results and more — is a completely different kettle of fish.

For one thing, providers must control access to medical information stored in their EMR in a far more sophisticated way than they had with paper charts.  For example, while role-based access to data may not sound too threatening to your average IT boss, it’s not exactly intuitive if you’re not a geek. Figuring out just who should get access to what gets a lot more complicated than when you used to just have to pull and route a chart.

Another issue: few clinicians know much about data security, and it’s not likely that they’re going to suddenly get wildly excited about encryption or VPNs.  Sure, you can warn them that it comes down to whether some random stranger (or even a staff member) will steal their patients’ Social Security numbers or broadcast medical secrets. But it’s just about impossible to explain security issues without wandering into scary jargon that will alienate the heck out of many doctors.

Of course, healthcare organizations can make sure their clinicians are trained to understand the importance of  securing their EMR. And they can even explain why specific types of security measures will limit their HIPAA exposure, the best pitch you can make to non-techies.

Still, the bottom line is that moving from paper to EMRs isn’t just a change-management exercise. It forces clinicians to think about how they use, distribute and share data on a profound level. I hope it does, anyway…cause if providers aren’t ready to think about these issues, things aren’t going to be pretty.

Much ink has been spilled discussing why physicians are resistant to adopting EMRs.

The thing is, it’s really no mystery.  Researchers have arrived at what seem like sensible answers to the question, including a) problems changing their work habits, b) fear of the unknown and c) struggles with kludgy interfaces.

So, why not take these problems on directly? While we can’t get inside clinicians’ heads and tell them how to think, we can address their issues concretely.

If the anecdotes I hear are accurate, many are pushed into EMR use and forced to do all the adapting, rather than getting the help they need.

So how can we help?

Obviously, physicians and other clinical staffers need access to accessible, intelligent training — ideally, both Web-based and live — as well as easy-to-use documentation that’s written in very simple language.

But that’s not all. While many institutions breeze by this step, IT departments (or consultants) should do everything they can to customize the EMR experience for individual clinicians. (If your EMR is too rigid to allow for this, that’s another story, but let’s pray you have one with some flexibility built in.)

It’s also important to pinpoint what other frustrations clinicians may have. For example, some doctors who type poorly are immensely frustrated by using EMRs, something keyboard-savvy techs might never consider.  A good old-fashioned typing course might work wonders in those cases.

In the rush to deal with the complex technical issues involved in EMR integration, it’s easy to blow by the needs of individual users.  It’s even easier to throw some fragmentary training at clinicians and assume they have a bad attitude if it doesn’t “take.”

The truth is, though, that nobody can afford to be short-sighted about getting users connected to EMRs.  Let’s hope everyone bears this in mind as the main wave of rollouts begins.

I was recently sent an Information Week article on the “Steady Bleed: State of HealthCare Data Breaches.” The article basically tries to list out all of the data breaches that are happening in healthcare and how healthcare companies aren’t doing what they need to do to protect patient data.

Now, I’ll be the first to acknowledge that more can always be done. I even agree that more can and needs to be done to protect patient information. However, I don’t agree with the article’s assertion that the use of an electronic health record (EHR) is the reason why health care providers are so poorly securing patient information.

Many of you might remember my post on EMR and EHR about HIPAA Breaches related to EMR. In that post, I discuss how it’s unfair for someone to automatically assume that if there was a breach, then it was the electronic medical record software’s fault. In the analysis I did in the above post, I found that most of the HHS list had nothing to do with EMR software. In fact, many of the HIPAA breaches were lost devices which contained lists of insurance information. EHR had nothing to do with that.

I’m not saying that breaches don’t happen with an EMR. They do. However, most of the examples given in the Information Week article could have happened just as easily in the paper world. It didn’t take an electronic health record for people to start looking up famous sports stars health information.

Maybe the real difference with an EHR is that now we can know and track who accesses each patient record. That just means that now we actually know about all the violations whereas with paper charts they’d just happen and we’d likely never know about it or have a way to prove that it happened. So, yes, the number of reported HIPAA breaches should be going up. We have more information to report on.

The good thing long term is that with an EHR we now have tracking mechanisms that allow us to hold someone accountable for their breaches of HIPAA. If this accountability is taken seriously, the number of breaches will go down. That’s a much better long term solution than the naive ignorance of not knowing about breaches in the paper chart world.

Sure not all EHR software is secure. They need to fix that and improve that. However, the numbers and reports I’ve seen don’t seem to indicate that breaching an EHR software’s security is the real problem. There are far easier ways to take patient data than trying to breach an EHR’s security system. Let’s focus on those other ways that people take patient data and punish it appropriately. That’s far more productive than saying that we’re rushing too quickly into an unsecured EHR world.

I’m interested to know what topics my readers would like me to blog about on EMR and HIPAA. I don’t ask because I don’t have plenty of topics already. I have 200+ draft posts that I could choose from. Not to mention the 20+ blog posts that I bet I can do based on the topics I heard discussed and thought of during the Las Vegas EMR conference I attended last week.

The reason I’m interested is that I prefer to write about topics that interest my readers. So, if you have a favorite topic I should cover, let me know. I’ll grease the tires by providing some common general topics that I’ve been writing about and you can let me know in the comments which ones you’d like to learn more about or even specific questions or topics I can use for future blog posts.

Ok, here goes (each topic is linked to posts I’ve done related to that topic):

EMR Stimulus (ARRA-HITECH)
Meaningful Use
Certified EHR
EMR Selection
EMR Consulting
EMR Vendors
EMR Consulting
EMR Implementation
EMR Backlog
Regional Extension Centers (RECs)
EMR Technology
Social Media
EMR Interoperability
Open Source EMR
SaaS EMR

Ok, make your voices heard. I love input!!

Many of you have likely noticed that I like to use the terms EMR and EHR almost synonymously. In fact, it’s kind of a game for me now. I generally try to stick with one term for a certain blog post, but I even break that rule on occasion. I guess the thing is that it really doesn’t matter to me at all.

I don’t like to debate the meanings and definitions of words since it doesn’t matter how you define a term. Instead, I just try and communicate the substance of the issues. Words matter as part of that communication, but whether I call it an EMR or an EHR doesn’t change the value of what I’m trying to communicate (at least 99% of the time).

There are a few rare cases when I do differentiate. For example, I would likely never say that you need a “certifed EMR” to get the available HITECH Act stimulus money. I wouldn’t do so because the legislation specifically says “certified EHR” and so I’d respect the verbiage. Although, these cases are few and far between.

Plus, I try to be the voice of the physician. I’d bet if you asked most physicians the difference between an EMR and EHR they’d likely laugh, walk away or know what an EMR was but ask you to define the term EHR. I, like most physicians, don’t care what you call it. They (and I) care more about the substance of selecting, implementing, using, maximizing, enjoying and even sometimes enduring an EMR or EHR.

I imagine that many of my readers use Twitter to find EMR information. Twitter is an interesting beast. It takes a little getting used to, but can be used in a whole number of ways. However, what people don’t realize is that you don’t have to be on Twitter and have a Twitter account to enjoy many of the benefits of Twitter.

I especially like Twitter during conferences. For example, during the HIMSS 2010 conference I would just search for the tag HIMSS2010 and found all sorts of interesting information about what was happening at HIMSS. Here’s a simple search for people talking about EMR on Twitter.

I think one of the main uses of Twitter is a way to share some of my favorite EMR links. I use this EHR and HIT twitter account to do that for some of my favorite bloggers. It’s also fun to see people’s reactions to the various items I post on that account. I guess people like what I’ve done since that account has 4232 followers of it.

At the end of the day, Twitter for me is a way for me to connect with lots of interesting people. Tomorrow, I’m going to lunch with a local CPA and blogger that I met on Twitter. It’s timely, since I’ve been looking around for a CPA. So, we’ll share lunch, I’ll teach him about blogging and we’ll see if his CPA services are a good fit for my needs.

Beyond that I’ve connected with so many people on Twitter. I’ve gotten free tickets to shows in Las Vegas. I’ve gotten free graphic design work. I’ve seen some of the latest breaking news before CNN and the likes are broadcasting it. I’ve found side work on Twitter. Plus, I’ve gotten hundreds of questions answered by my smart twitter friends.

Obviously, I’m a pretty big fan of Twitter. In fact, many of you likely found this blog through Twitter. I love Twitter because it can be used in so many ways. How do you use Twitter?

Also, if you want to connect to my personal twitter account (which also does quite a bit of EMR related content), I’m @techguy.

In my previous post about the benefits of inter operable EMR software, Russ Reese left the following comment about the benefits of CPOE and whether CPOE will make it into the ARRA EMR stimulus requirements or not. Plus, he ends with an interesting thought about the EMR stimulus program. I thought it was interesting and more people should read it and comment.

Here is a link to a study that showed some positive results for EMR use – http://jamia.bmj.com/content/17/1/78.full

“Conclusions: A basic CPOE system in a community setting was associated with a significant reduction in medication errors of most types and severity levels.”

Note, this study is about CPOE which is not featured in all EMRs and I think that HIMMS has even been trying to get HHS to back off on making CPOE required for the stimulus $.

But here is real data that shows real benefits. This study is about error rates and not dollars – but if errors are reduced then lawsuits are reduced and hopefully malpractice insurance premiums follow.

IMO, we never needed the tax payer funded stimulus to begin with. Malpractice insurance companies should offer radically reduced rates to physicians that use CPOE and that would be all the “stimulus” that is needed to move doctors toward EHR.